The Rehabilitation Team
THE PATIENT and FAMILY are the central members of the team. Working on recovery takes the efforts of a large group of people who communicate with each other.
PHYSIOTHERAPISTS assess and treat the patient to try to maintain joint flexibility, to help him relearn normal patterns of movement and to improve strength and exercise tolerance.
OCCUPATIONAL THERAPISTS assess and treat cognitive and perceptual problems. In addition, they work closely with physiotherapists in maintaining functional joints and in muscle strengthening. Dressing, grooming skills, etc. are assessed and practiced as necessary.
SPEECH LANGUAGE PATHOLOGISTS (speech therapists) also provide cognitive assessment and treatment. As well, therapists deal with the mechanics of both speech and swallowing and the ability to express thoughts in words.
SOCIAL WORKERS work with both the patient and the family to help them deal with the ongoing emotional and practical problems which accompany head injury both during and after hospitalization.
REHABILITATION NURSE The nurse takes care of a lot of the day-to-day health needs of the patient however rehabilitation is a little different. The nurse, working with the rehabilitation team, determines what parts of his daily care the person with brain injury can do on his own or perhaps with just a little help. In this way, the nurse helps him ‘do for himself’.
PSYCHOLOGISTS complete detailed assessments of the patient’s memory, thinking and processing to see how recovery is progressing and target areas for improvement.
REHABILITATION DOCTORS manage the medical issues that arise during rehabilitation such as an infection and they also assess and help determine the patient’s need for special splints or medications.
Some tips for the rehabilitation team
Interdisciplinary team management of the patient is a must!
This is the cornerstone of effective management of the brain injured patient. Team members must work together to provide management consistency. Communication between members is critical and frequent meetings are a real help in this regard. The patient can only benefit from this approach. Your own professional staff and concerned family members are your best resources!
Treat the patient as an adult.
Sometimes the person with brain injury will experience a distressing change in behavior. For families, they may feel the patient may behave in a more child-like way but it is important to recognize that they are not children. Avoid scolding or “talking down to” the person with brain injury. This will only aggravate. Be sensitive and allow the patient as much control, respect, and responsibility as his behavior will permit.
Rehabilitation from brain injury is a LEARNING process.
Though most of the problems of the brain-injured patient come from manifestations of impaired brain functioning, the technique of restoring the lost abilities of the patient is learning. The rehabilitation process is much more a learning process than a medical process. Learning comes from daily practice, feelings of success, gradual challenges and reminders.
Be patient with challenging behaviours.
You cannot change all the behavioral problems of a patient, and what you can change usually is accomplished very slowly. The patient is recovering from a brain injury with an impaired capacity for learning new things. Many changes just have to wait until the brain is able to incorporate the new learning into ongoing behavior. Also, though the ultimate goal is to change the patient for the better, sometimes just finding a suitable environment to accommodate unchanged behavior can be the only manageable outcome.
Try not to over stimulate the patient who is confused or agitated.
Too many demands placed on a brain-injured patient just add to confusion. These patients, especially in the early stages of recovery, need time to rest and regroup their meager resources. Families are often guilty of frantically trying to stimulate the patient into spontaneous recovery, as is seen on television shows and in popular literature. The recovery process is a lengthy one and that the patient can only deal with so much stimulation before becoming overwhelmed.
Be consistent in managing behavior.
This applies to both within and between family and staff members. Treat the patient the same from day to day, giving him the needed stability in a confusing world. Also, through communication and team treatment, have everyone working with the patient managing behavior in the same fashion. It does not take much deviation to confuse a brain-injured patient. He is not sure how his behavior impacts on others as it is. We have to consistently help him understand and develop stable interpersonal behavior.
Model calm and controlled behavior for the patient.
Patients with brain injuries can pick up on nonverbal cues even better than they can sometimes respond to verbal suggestions or commands. They pick up much of their impressions of others from body language, facial postures, and movements. Try to model calm, cool, and friendly behavior for the patient whenever possible, especially when the patient is agitated, irritable, or frightened. Calm demeanor will help reduce the patient’s fear and anxiety.
Expect the unexpected — variability is the rule.
We all have our ups and downs, but brain-injured patients have even more variability in their day-to-day behavior. These mood changes, differences in attention span and alertness, and ability to do even daily living activities will be different from day to day and even minute to minute. Try to help the patient remain as steady as possible in daily activities.
Brain-injured patients are more sensitive to stress.
Traumatically brain-injured patients are very sensitive to disruptions of routine, surprises, lack of sleep or change of sleep patterns, colds or minor illnesses, drugs and alcohol, and fatigue, as well as a multitude of other stressors. Their performance can be drastically altered by these relatively minor stressors. They must often give 100% of their ability just to do minor tasks, and any disruption due to stress can make them ineffective. Try to reduce the impact of these stressors on the patient as much as possible. Make allowances in the daily routine of the patient under stress to give more breaks, lessen the difficulty of demands, and yet still give needed structure and guidance to the patient.
When behavior becomes too much, redirect the focus
Whenever the patient is agitated, combative, confused, perseverating, or exhibiting any number of disruptive and frightening behaviors, confrontation or restraint of the patient usually is not effective. Instead, get the patient’s attention and simply redirect the attention to another topic, stimulus, or person. Brain-injured patients, as a rule, will respond to this technique, and the emotionality connected with the disruptive episode usually will fade quickly and be forgotten as the patients attention focuses on something else.